5 PREFACE The Standardized Field Sobriety Testing (SFST) training prepares police officers and other qualified persons to administer and interpret the results of the SFST battery. This training under the auspices and direction of the International Association of Chiefs of Police (IACP) and the National Highway Traffic Safety Administration (NHTSA) has experienced remarkable success in detecting and apprehending intoxicated drivers since its inception in the 1980s. As in any educational training program, an instruction manual is considered a living document that is subject to updates and changes based on advances in research technology and science. A thorough review is made of information by the Drug Evaluation Classification Program (DECP) Technical Advisory Panel (TAP) of the Highway Safety Committee of the IACP with contributions from many sources in health care science, toxicology, jurisprudence, and law enforcement. Based on this information, any appropriate revisions and modifications in background theory, facts, examination and decision making methods are made to improve the quality of the instruction as well as the standardization of guidelines for the implementation of the SFST Training Curriculum. The reorganized manuals are then prepared and disseminated, both domestically and internationally. Changes will take effect 90 days after approval by the TAP, unless otherwise specified or when so designated by NHTSA/IACP or the DEC Program state coordinator.

6 SFST Introduction to Drugged Driving Session Overview Introduction to Drugged Driving Learning Objectives Define the term drug in the context of DWI enforcement Describe the incidence of drug involvement in motor vehicle crashes and DWI enforcement Name the categories of drugs 1-2 At the conclusion of this session, participants will be able to: Define the term "drug" in the context of DWI enforcement Describe in approximate, quantitative terms the incidence of drug involvement in motor vehicle crashes and in DWI enforcement Name the categories of drugs Session Overview Introduction to Drugged Driving Learning Objectives (Cont.) Describe the observable signs of impairment usually associated with the major drug categories Describe medical conditions and other situations that can produce similar signs of impairment Describe appropriate procedures for dealing with drug impaired or medically impaired suspects 1-3 Learning Objectives (Cont.) Describe the observable signs usually associated with the drug categories Describe medical conditions and other situations that can produce similar signs Describe appropriate procedures for dealing with drug impaired or medically impaired suspects. CONTENT SEGMENTS LEARNING ACTIVITIES A. Overview Instructor Led Presentations B. Eye Examinations: Detecting Signs of Participant Practice Drug Influence C. Drug Categories and Their Observable Effects D. Combination of Drugs E. Dealing with Suspected Drug Influence or Medical Impairment HS 178 R5/13 1 of 29

7 Session Overview Introduction to Drugged Driving Session Purpose Improve your ability to recognize suspects who may be medically impaired or impaired by drugs other than alcohol and, when you encounter such suspects, take appropriate action 1-4 A. Overview The purpose of this session is to improve your ability to recognize suspects who may be medically impaired or impaired by drugs other than alcohol and, when you encounter such suspects, take appropriate action. Alcohol certainly remains the most frequently abused drug, and most impaired drivers are under the influence of alcohol Many other drugs also are routinely abused by many drivers. It is highly likely that every experienced DWI enforcement officer has encountered at least some drivers who were under the influence of drugs other than alcohol. Depending upon the specific types of drugs they have taken, some drug-impaired drivers may look and act quite a bit like persons who are under the influence of alcohol, but others will look and act very differently from alcohol-impaired drivers. It is important that you be able to recognize subjects who may be under the influence of other drugs, so that you will know when to summon assistance from physicians or other appropriate persons, or trained drug recognition experts. (DREs) HS 178 R5/13 2 of 29

8 Session Overview Introduction to Drugged Driving This Training Will NOT Important issue this training will NOT qualify you to perform the functions of a Drug Recognition Expert 1-5 One important thing that this session will not accomplish: it will NOT qualify you to perform functions of a Drug Recognition Expert (DRE). Officers become DREs only after they have completed a very challenging program that includes nine days of classroom training and many weeks of closely-supervised on-thejob training. (Two-Day Pre-School followed by Seven-Day classroom training.) Session Overview Introduction to Drugged Driving What is a Drug? Working Definition of Drug: Any substance that, when taken into the human body, can impair the ability of the person to operate a vehicle safely 1-6 Definition of Drug The word drug is used in many different ways, by many different people. The corner druggist and the U.S. Drug Enforcement Administration are both concerned with drugs, but they don t have exactly the same thing in mind when they use that word, and neither the druggist nor the DEA have the same perspective as the DWI enforcement officer. For our purposes, a drug: is: Any substance when taken into the human body, can impair the ability of the person to operate a vehicle safely. This definition excludes some substances that physicians consider to be drugs. This definition includes some substances that physicians don't usually think of as drugs. HS 178 R5/13 3 of 29

9 Session Overview Introduction to Drugged Driving How Many People Use Drugs? Because many drugs are illegally manufactured, sold and consumed, it is difficult to determine how many people actually use the various drugs All available information shows that drug use and abuse are widespread among large segments of the American public 1-7 How many people use drugs? Because many drugs are illegally manufactured, sold and consumed, it is difficult to determine how many people actually use the various drugs. All available information shows that drug use and abuse are widespread among large segments of the American public. Session Overview Introduction to Drugged Driving 2011 National Survey on Drug Use and Health: National Findings 8.7% of the population aged 12 years or older were current illicit drug users Marijuana continues to be the most commonly used illicit drug 6.7 million people were users of psychotherapeutic drugs taken non medically Estimated 1.4 million persons were current Cocaine users 1-8 Results from the 2011 National Survey on Drug Use and Health: National Findings In 2011, 8.7% of the population aged 12 years or older were current illicit drug users. Marijuana was the most commonly used illicit drug in 2011, with 18.1 million users. In 2011, 6.7 million people were users of psychotherapeutic drugs taken non medically In 2011, an estimated 1.4 million persons were current Cocaine users Source: Results from the 2010 National Survey on Drug Use and Health: National Findings HS 178 R5/13 4 of 29

10 Session Overview Introduction to Drugged Driving Facts University of Tennessee found 40% of crash injured drivers had drugs other than alcohol in them The Maryland Shock Trauma Center found nearly one third of crash injured drivers had recently used marijuana 1-9 Evidence of drug use frequently shows up in people killed or injured in motor vehicle crashes. Fact: University of Tennessee (1988) found 40% of crash injured drivers had drugs other than alcohol in them. Fact: The Maryland Shock Trauma Center (1986) found nearly one-third of crash injured drivers had recently used Marijuana. Studies of fatally-injured drivers consistently show that nearly 20% had drugs or the combination of drugs and alcohol in their systems at the time of the crash. Source: FARS, 2010 Session Overview Introduction to Drugged Driving Eye Examinations: Detecting Signs of Drug Influence 1-10 B. Eye Examinations: Detecting Signs of Dug Influence The eyes disclose some of the clearest signs of drug impairment or medical conditions. Horizontal gaze nystagmus is a very clear indication, in subject s eyes, of possible alcohol impairment. There are a number of drugs, other than alcohol, that will cause horizontal gaze nystagmus. There are a number of other drugs that will not cause horizontal gaze nystagmus. There are many other clues that the eyes will disclose, all of which will suggest the presence or absence of drugs or medical impairment. HS 178 R5/13 5 of 29

11 Session Overview Introduction to Drugged Driving Eye Examinations Overview The eye examinations that you can conduct to assess possible drug or medical impairment include: Resting nystagmus Tracking ability Pupil size Horizontal gaze nystagmus (HGN) Vertical gaze nystagmus (VGN) 1-11 Eye Examinations Overview: The eye examinations that you can conduct to assess possible drug or medical impairment include: Resting nystagmus Tracking ability Pupil size Horizontal gaze nystagmus (HGN) Vertical gaze nystagmus (VGN) Resting Nystagmus is referred to as jerking as the eyes look straight ahead. This condition is not frequently seen. Its presence usually indicates a pathological disorder or high doses of a Dissociative Anesthetic drug such as PCP. Tracking Ability will be affected by certain categories of drugs, and also by certain medical conditions or pathological disorders. If the two eyes do not track together, the possibility of a medical condition or injury is present. By passing a stimulus across both eyes, you can check to see if both eyes are tracking equally. HS 178 R5/13 6 of 29

12 Session Overview Introduction to Drugged Driving Eye Examinations Overview (Cont.) Tracking ability will be affected by certain categories of drugs, and also by certain medical conditions or pathological disorders 1-12 Tracking Ability will be affected by certain categories of drugs, and also by certain medical conditions or pathological disorders. If the two eyes do not track together, the possibility of a medical condition or injury is present. By passing a stimulus across both eyes, you can check to see if both eyes are tracking equally. If they don t (i.e., if one eye tracks the stimulus, but the other fails to move, or lags behind the stimulus) there is the possibility of a pathological disorder. If a person has sight in both eyes, but the eyes fail to track together, there is a possibility that the person is suffering from an injury or illness. HS 178 R5/13 7 of 29

13 Session Overview Introduction to Drugged Driving Pupil Size Pupil size will be affected by several categories of drugs, and also by some medical conditions or injuries. Drugs causing pupil dilation: CNS stimulants Hallucinogens Cannabis 1-13 Pupil Size Pupil Size will be affected by several categories of drugs, and also by some medical conditions or injuries: If the two pupils are distinctly different in size, it is possible that the subject has a glass eye, or is suffering from a head injury or a neurological disorder. If the pupils are noticeably dilated, then the possibility exists that the subject could be impaired by certain categories of drugs: CNS stimulants Hallucinogens Cannabis Session Overview Introduction to Drugged Driving Pupil Size (Cont.) If the pupils are noticeably constricted then the possibility exists that the subject could be impaired by a narcotic analgesic 1-14 Pupil Size (Cont.) If the pupils are noticebly constricted then the possiblity exists that the subject could be impaired by a narcotic analgesic. CNS Depressants, Dissociative Anesthetics, and Inhalants usually do not affect pupil size. HS 178 R5/13 8 of 29

14 Session Overview Introduction to Drugged Driving Horizontal Gaze Nystagmus (HGN) The Test of Horizontal Gaze Nystagmus (HGN) for subjects is identical to the HGN test for alcohol-impaired subjects. First Clue: lack of smooth pursuit Second clue: distinct and sustained nystagmus at maximum deviation Third clue: onset of nystagmus prior to 45 degrees 1-15 Horizontal Gaze Nystagmus The test of Horizontal Gaze Nystagmus (HGN) for subjects is identical to the HGN test for alcohol-impaired subjects. First Clue: Lack of smooth pursuit Second clue: Distinct and sustained nystagmus at maximum deviation Third clue: Onset of nystagmus prior to 45 degrees If the eyes track equally, but jerk while they are moving, then the possible presence of three categories of drugs should be noted: Central Nervous System Depressants Dissociative Anesthetics Inhalants Session Overview Introduction to Drugged Driving PCP May Cause Immediate Onset of Nystagmus The angle of onset becomes of special interest when a subject is under the influence of a Dissociative Anesthetic such as PCP 1-16 PCP May Cause Immediate Onset of Nystagmus PCP impaired subjects may exhibit immediate onset, i.e., the jerking begins virtually as soon as the eyes start to move toward the side. Sometimes, PCP- impaired subjects will exhibit resting nystagmus, i.e., the eyes jerk while they are looking straight ahead. HS 178 R5/13 9 of 29

15 Session Overview Introduction to Drugged Driving Vertical Nystagmus 1-17 Vertical Nystagmus The Vertical Nystagmus test is very simple to administer. Position the stimulus horizontally. Approximately inches (30-38 cm) in front of the subject s nose. Instruct the subject to hold their head still, and follow the stimulus with the eyes only. Raise the stimulus until the subject s eyes are elevated as far as possible, hold for a minimum of four seconds. Watch closely for evidence of jerking (up and down). Vertical Nystagmus may be present in subjects under the influence of CNS depressants or inhalants. HS 178 R5/13 10 of 29

17 Session Overview Introduction to Drugged Driving Central Nervous System (CNS) Depressants Alcohol Barbiturates (Secobarbital) Non barbiturates (GHB/Soma) Anti-Anxiety Tranquilizers(Valium/Xanax) Anti-Depressants (Prozac/Elavil) Muscle relaxants 1-19 Central Nervous System (CNS) Depressants CNS Depressants slow down the operations of the brain, and usually depress the heartbeat, respiration, and many other processes controlled by the brain. The most familiar CNS Depressant is alcohol. Other CNS Depressants include: Barbiturates (such as Secobarbital (Seconal), and Pentobarbital (Luminal)) Non-Barbiturates (GHB-gamma-hydroxybutyrate and Soma) Anti-Anxiety Tranquilizers (Such as Valium, Librium, Xanax, and Rohpynol) Anti-Depressants (such as Prozac and Elavil) Muscle relaxants and many other drugs (Soma) CNS Depressants usually are taken orally, in the form of pills, capsules, liquids, etc. In general, people under the influence of any CNS Depressant look and act like people under the influence of alcohol. HS 178 R5/13 12 of 29

19 Session Overview Introduction to Drugged Driving Cocaine Central Nervous System (CNS) Stimulants Amphetamines Methamphetamine 1-21 Central Nervous System Stimulants Central Nervous System Stimulants accelerate the heart rate, respiration and many other processes of the body. The two most widely abused kinds of CNS Stimulants are cocaine and methamphetamines. Cocaine is made from the leaves of the coca plant. Methamphetamines are chemically produced (manufactured) drugs. Cocaine abusers may take the drug: By snorting By smoking (freebase, or Crack ) By injection Orally Abusers of amphetamines may take their drugs: By injection Orally By snorting Smoked (i.e., ice ) HS 178 R5/13 14 of 29

20 Session Overview Introduction to Drugged Driving Indicators of CNS Stimulant Influence People under the influence of CNS Stimulants tend to be hyperactive, indicated by nervousness, extreme talkativeness and an inability to sit still They also are usually unable to concentrate, or to think clearly for any length of time 1-22 General indicators of CNS Stimulant influence: People under the influence of CNS Stimulants tend to be hyperactive, indicated by nervousness, extreme talkativeness and an inability to sit still. They also are usually unable to concentrate, or to think clearly for any length of time. Restlessness Talkative Excitation Euphoria Exaggerated reflexes Loss of appetite Anxiety Grinding teeth (bruxism) Redness to nasal area (if snorting ) Body tremors Eye indicators of CNS Stimulant Influence: Neither horizontal nor vertical nystagmus will be observed The pupils generally will be dilated. HS 178 R5/13 15 of 29

21 Session Overview Introduction to Drugged Driving Peyote Salvia Divinorum LSD MDMA (Ecstasy) Hallucinogens 1-23 Hallucinogens Hallucinogens are drugs that affect a person s perceptions, sensations, thinking, selfawareness and emotions. One common type of hallucination caused by these drugs is called synesthesia, which means a transposing of the senses. Sounds for example, may be transposed into sights. Sights, for example, may be transposed into odors or sounds. Some hallucinogenic drugs come from natural sources: Peyote is an hallucinogen found in a particular specie of cactus. Psilocybin is an hallucinogen found in a number of species of mushroom. Other hallucinogens are synthetically manufactured: LSD (Lysergic Acid Diethylamide) MDA (3, 4-Methylene-dioxyamphetamine) MDMA (Ecstasy) Many others HS 178 R5/13 16 of 29

23 Session Overview Introduction to Drugged Driving Dissociative Anesthetics Phencyclidine (PCP) Ketamine Dextromethorphan 1-25 Dissociative Anesthetics Dissociative Anesthetics is the category of drugs that includes PCP, its various analogs, and Dextromethorphan (DXM). PCP is a synthetic drug that was first developed as an intravenous anesthetic. Because PCP produces very undesirable side effects, it is no longer legally manufactured. However, an analog (chemical cousin) Ketamine is still being legally manufactured and available. However, it is easy to manufacture: The formula for making PCP and PCP analogs have been widely publicized. The manufacturing process involves readily available chemicals. Many Dissociative Anesthetic users smoke the drug, by using it to adulterate tobacco, marijuana, or various other substances. Dissociative Anesthetics can also be taken orally or by injection, or inhaled. HS 178 R5/13 18 of 29

25 Session Overview Introduction to Drugged Driving Heroin Morphine Codeine Narcotic Analgesics Synthetic Opiates (e.g., Demerol, Methadone, Fentanyl) 1-27 Narcotic Analgesics Narcotic Analgesics include a large number of drugs that share three important characteristics: They will relieve pain. They will produce withdrawal signs and symptoms, when the drug is stopped after chronic administration. They will suppress the withdrawal signs and symptoms of chronic morphine administration. Some drugs classified as Narcotic Analgesics are natural derivatives of opium: Heroin Morphine Codeine Some are synthetic narcotic analgesics, such as: Demerol Methadone Numorphan Fentanyl OxyContin HS 178 R5/13 20 of 29

26 Session Overview Introduction to Drugged Driving Tolerance An important characteristic of narcotic analgesics is that users develop tolerance to them Tolerance means that the same dose of the drug will produce diminishing effects, or that a steadily larger dose is needed to produce the same effects 1-28 Tolerance An important characteristic of narcotic analgesics is that users develop tolerance to them. Tolerance means that the same dose of the drug will produce diminishing effects, or that a steadily larger dose is needed to produce the same effects. A tolerant user who has taken his or her normal dose of heroin (for example), may exhibit little or no evidence of physical impairment. Session Overview Introduction to Drugged Driving Indicators of Narcotic Analgesic Influence On the nod Droopy eyelids Depressed reflexes Dry mouth Facial itching Low, raspy speech Fresh puncture marks may be evident 1-29 General indicators of Narcotic Analgesic influence: On the nod Droopy eyelids Depressed reflexes Dry mouth Facial itching Low, raspy speech Fresh puncture marks may be evident Eye indicators of Narcotic Analgesic influence: Neither horizontal nor vertical nystagmus will be present HS 178 R5/13 21 of 29

30 Session Overview Introduction to Drugged Driving Indicators of Cannabis Influence Marked reddening of the Conjunctiva (white part of the eyeball) Body tremors Odor of marijuana Disoriented Relaxed inhibitions Difficulty in dividing attention 1-33 General Indicators of Cannabis Influence: Marked reddening of the Conjunctiva (white part of the eyeball) Body tremors Odor of marijuana Disoriented Relaxed inhibitions Difficulty in dividing attention Eye indicators of Cannabis Influence: Neither horizontal nor vertical nystagmus will be present Pupil size generally will be dilated, but also may not be effected HS 178 R5/13 25 of 29

31 Session Overview Introduction to Drugged Driving Combinations of Drugs Poly derives from the Greek word for "many" In the Los Angeles Field Study (1985), 81 of the 173 suspects (47%) in the Los Angeles Field Study had alcohol in combination with one or more other drugs 1-34 D. Combinations of Drugs Many drug users routinely ingest drugs from two or more drug categories at the same time. The term for this condition is "polydrug use". In the Los Angeles Field Study (1985), 72% of the suspects had two or more drugs in them. In that study, alcohol was often found in combination with one or more other drugs. But even if we discount alcohol, nearly half (45%) of the Field Study suspects had two or more other drugs in them. HS 178 R5/13 26 of 29

32 Session Overview Introduction to Drugged Driving Common Combinations of Drugs Alcohol and some other drug PCP and Cannabis Cocaine and Heroin 1-35 Common Combinations of Drugs Alcohol and some other drug is the most frequent combination PCP and Cannabis is another common combination Cocaine and Heroin is another common combination Because polydrug use is so common, you should not be surprised to encounter subjects who are under the influence of more than one category of drugs. At some times and places polydrug users may be more common than single drug users. Be especially alert to the possibility that subjects who have been drinking alcohol may also have ingested some other drug or drugs. The effects of polydrug use may vary widely, depending on exactly what combination of drugs is involved, how ingested and when they were ingested. HS 178 R5/13 27 of 29

33 Session Overview Introduction to Drugged Driving Possible Effects of Drug Combinations Null Overlapping Additive Antagonistic 1-36 Any particular combination of drugs may produce four general kinds of effects: Null: Neither drug has an effect on the indicator. Overlapping: Each drug may effect the subject in some different way. In combination, both effects may appear. Additive: The two drugs may independently produce some similar effects. In combination, these effects may be enhanced. Antagonistic: The two drugs may produce some effects that are exactly opposite. In combination, these effects may mask each other. Example of Antagonistic Effect: A CNS Stimulant usually causes pupil dilation. A narcotic usually causes pupil constriction. It is possible that someone who is simultaneously under the influence of a stimulant and narcotic may have pupils that are nearly normal in size. It is also possible that the pupils will change as the effects of one drug diminishes while the other increases. Session Overview Introduction to Drugged Driving Dealing With Suspected Drug Influence or Medical Impairment 1-37 HS 178 R5/13 28 of 29

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